Adjuvant cross-linking doesn’t appear beneficial for bacterial keratitis

Adjuvant cross-linking (CXL) did not appear beneficial in the primary treatment of moderate bacterial keratitis, according to clinical trial results published in Cornea. However, the researchers noted that CXL may reduce culture positivity and complication rates.

In this outcome-masked, randomized controlled clinical trial, study eyes of patients with a smear-positive bacterial ulcer were randomized to receive topical moxifloxacin 0.5% or topical moxifloxacin 0.5% plus CXL. Microbiological cure at 24 hours on repeat culture was the primary outcome; secondary outcomes were best spectacle corrected visual acuity, percentage of study participants with epithelial healing, infiltrate and/or scar size all at 3 weeks and 3 months.

At 24 hours, patients in the CXL group had 0.60 decreased odds of culture positivity. At 3 months, patients in the CXL group had 0.9 logarithm of the minimum angle of resolution lines worse visual acuity and 0.9 logarithm of the minimum angle of resolution lines worse visual acuity.

Fewer corneal perforation or therapeutic penetrating keratoplasty were needed in patients receiving CXL.

Reference
Prajna NV, Radhakrishnan N, Lalitha P, et al. Cross-linking assisted infection reduction (CLAIR): A randomized clinical trial evaluating the effect of adjuvant cross-linking on bacterial keratitis. Cornea. 2021;40(7):837-841.